Coma cocktail

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The term coma cocktail refers to a combination of substances administered in an emergency to comatose individuals,[1] at a time when the cause of the coma in the individual was not yet known.

A standard combination included dextrose (1 Amp D50W IV), flumazenil (0.2 mg IV), naloxone (2 mg IV), and thiamine (100 mg IV).[2] It has been suggested that the use of naloxone and flumazenil be administered more selectively than glucose and thiamine.[3]

Some have proposed that the concept be abandoned completely because modern EMS providers should be able to determine the likely etiology of the change in mental status. At a minimum, the clinical presentation of the patient should rule in or out some portions of the coma cocktail.[4] For example, with the advent and widespread implementation of glucometers, the indications for administering glucose can be more narrowly defined and its use more regimented.[5]


The coma cocktail is thought to have been created in United States as a first line treatment for an unconscious patient in an era where intensive care was new and difficult to maintain. Original coma cocktails included methylxanthines, physostigmine, physical stimulation (such as cold water baths or ammonium carbonate ("smelling salts")), amphetamines, strychnine, picrotoxin, nikethamide and camphor. As medicine and assessment techniques have advanced, the proceeding drugs have been mostly replaced by the modern coma cocktail as described above.[5]


  1. ^ Bartlett D (December 2004). "The coma cocktail: indications, contraindications, adverse effects, proper dose, and proper route". J Emerg Nurs. 30 (6): 572–4. doi:10.1016/j.jen.2004.09.002. PMID 15565045. 
  2. ^ Doyon S, Roberts JR (May 1994). "Reappraisal of the "coma cocktail". Dextrose, flumazenil, naloxone, and thiamine". Emerg. Med. Clin. North Am. 12 (2): 301–16. PMID 8187685. 
  3. ^ Buylaert WA (December 2000). "Coma induced by intoxication". Acta Neurol Belg. 100 (4): 221–4. PMID 11233676. 
  4. ^ Bledsoe BE (November 2002). "No more coma cocktails. Using science to dispel myths & improve patient care". Journal of Emergency Medical Services. 27 (11): 54–60. PMID 12483195. 
  5. ^ a b Sivilotti, Marco L.A. (7 August 2015). "Flumazenil, naloxone and the 'coma cocktail'" (PDF). British Journal of Clinical Pharmacology (81 ed.). British Journal of Clinical Pharmacology. 3: 428–436. doi:10.1111/bcp.12731.